House of Commons Hansard Debates for 21 Feb 1995

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No final decisions have been taken on the proposals or the detailed issues which are out for consultation. We will take final decisions in the light of comments received. A reasonable period has been allowed for consultation and comments have been invited by 23 February. I reject the suggestion from some quarters that, because it took some months to work up proposals, a similar amount of time must be spent on consultation.

I do not wish to anticipate decisions on the three clinical services delivered by the common services authority. Clearly there is merit in placing them in NHS organisations with relevant clinical expertise, although we do not propose any change in the current arrangement for the blood transfusion service for the time being. As the House is aware, their location within the common services authority is for management purposes only.

Finally, it might be helpful if I set out the approach to the provision of clinical and non-clinical services generally. In the case of clinical services, decisions will be taken with a view to securing the most efficient and cost-effective results. Health authorities will commission services on that basis, and where it is appropriate for more than one to purchase together for a particular service, they will do so. With only five authorities in place from April 1996, subject to the passing of the Bill it will be possible for them to establish an all-Wales consortia to do so if that is appropriate.

I am glad to say that progress is being made on the work which has been under way within the common services authority to bring about market testing and the possible privatisation of non-clinical services. I wish to bring matters to a conclusion, and I am grateful for the support of the hon. Member for Cardiff, West, so that NHS trusts have the opportunity to purchase support services--information technology, supplies, estate design and maintenance--in the most cost-effective manner.

The establishment of NHS trusts means that decisions should be taken at the hospital level. Where it can be shown that there is an essential need to deliver services on an all-Wales basis, one option would be for authorities and trusts to create consortia. The common services authority accumulated a number of services before trusts were established and, therefore, there is no criticism intended of the staff concerned. We are now placing responsibility on trusts to obtain their services in a cost-effective manner.

Options for handling IT, supplies, estates design and maintenance will be ready for consideration in the next two months or so and, following that, tenders will be invited, as appropriate, for elements of activity. Until those exercises are completed, I cannot speculate on the outcome. However, I can assure the House that the whole exercise will be completed in the next financial year. The common services authority has already told its staff that my right hon. Friend wishes to have a small organisation in place by April 1997. The hon. Gentleman was quite wrong when he said that my Department had sent instructions to the common services authority to say that in-house bids would not be entertained. That is quite untrue: in-house bids will be allowed. I must stress that the April 1997 date has been set to allow for all detailed implementation arrangements to be carried through.

Mr. Morgan: Will the Minister clarify what kind of in-house bid he means? I illustrated two kinds in my

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remarks. Is he referring to the conventional kind of market-testing approach, whereby an in-house bid from within the civil service or a public agency is allowed; or does he mean a situation where the in-house team is allowed to buy itself out in a management- employee buy-out? If that is so, why has it not been given the legal and accountancy assistance which is normal in those circumstances to permit it to make a viable in-house bid outside involving the same people?

Mr. Richards: I was responding to the hon. Gentleman's comments because he asserted that the people already working within the common services authority would be excluded from making any form of bid. Without prescribing one form or another, they will not be excluded in the way that the hon. Gentleman implied.

There may be a need to consider with health authorities and NHS trusts how consortia can be established to run some of the services now located within the common services authority, and I would not wish at this stage to give an indication of the ultimate size of that organisation.

I share many of the points made by the hon. Gentleman. In particular, I was delighted that at the start of his remarks he welcomed the principle of the Bill of merging the district health authorities and the family health services authorities in Wales. There is agreement between us that delivering services in an efficient and cost-effective way is of paramount importance. I have outlined how we intend to achieve that for the reasons I stated. It is not necessary, however, to include such provision in the Bill, and I urge the House to reject the amendment.

Mr. Rogers: I shall be brief. The Minister ended his speech on a note of critical importance to any part of the reorganisation that is to take place, with his reference to efficiency and

cost-effectiveness. The Opposition accept that that is necessary, but quality standards and clinical effectiveness are also necessary in a national health service. A drive simply for efficiency and cost- effectiveness by a group of accountants, politicians or bureaucrats is losing sight of what the national health service is all about. Quality standards and clinical effectiveness are equally important. I am glad to see that the Secretary of State has arrived to hear my pearls of wisdom this evening. [Interruption.] As my hon. Friend the Member for Bridgend (Mr. Griffiths) says, she came back especially to listen to me.

I have a little problem with the amendment moved by my hon. Friend the Member for Cardiff, West, in that I am always concerned about over- centralisation. As I said earlier, the Welsh Office has great difficulty in coping with its functions and on occasions it appears to be breaking down. I hesitate to transfer willy-nilly all sorts of functions to the Welsh Office.

If there is to be a centrally imposed direction on the trusts, whether it be at health authority level or from the Welsh Office, it ought to be consistent, coherent and agreed generally with those who have to provide the services to the patients. The measure is not about good order in the Welsh Office, in health authorities or in the management of trusts, but about delivering services to patients. Lastly, in addition to being consistent, coherent and generally agreed, decisions must be made swiftly. One of the problems that practitioners face now, particularly in

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relation to standards being set across the board, is that the time taken to set those standards and implement them is quite inordinate. There is no doubt at all that all-Wales services are

appropriate--for instance, in genetics and national screening programmes. Breast Test Wales is a classic example of where it is necessary to carry out comparative epidemiological examinations of the facilities that are provided. Of course we have a special point--as I am sure the hon. Member for Ynys Mo n (Mr. Jones) is aware--in carrying out certain clinical facilities, but north Wales is often far better served from Mersey, the north-west and the west midlands.

I would hate us to continue talking about all-Wales provision of services on a nationalistic basis when services would be better provided from across the border in a much more efficient and coherent way. Perhaps the hon. Member for Ynys Mo n has a different perspective on the delivery of national services as such, but I am quite sure that the patients in north Wales, who are more crucial than any artificial boundaries, would appreciate the maintenance of the high-quality service often given by hospitals in Liverpool and Manchester to north-east Wales.

My hon. Friend was right to have tabled the amendment because there is enormous concern among health service providers in Wales about the size of the common services authority. I was pleased to hear the Minister saying that he was seeking to make sophisticated or to streamline the functions of that organisation. We have witnessed central management costs spiralling upwards, while at the same time there has been much pressure on reducing management costs in the NHS in Wales.

8.15 pm

I have been given to understand that there has been little consultation with NHS Wales on the future of the common services authority, but I take hope from what the Minister has said. If he carries out what he has promised, I am sure that some of the present fears will be overcome.

I said a little earlier that the problem of long time scales--for instance, in respect of the design of capital works by the CSA--could be resolved if there were proper dispersion of work to the appropriate level. There is evidence that the private sector could reduce those time scales without necessarily reducing the quality or the standard of the work, but I am concerned that certain standards are set.

I tried to intervene during the Minister's speech when he spoke about the standards that are evidently relevant for England and Wales in respect of designs and specifications. If he made those standards mandatory on trusts, as they will be drawing up the designs and contracting out capital works, that is the best level at which to implement them; on the other hand, if a trust feels that it can aim for a lower standard and lower specifications simply to save money, we shall again reduce the service to patients.

Mr. Gareth Wardell (Gower): I can think of no better example of his point than the siting of the Prince Phillip hospital in Llanelli, which was built on the site of two

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former coal shafts. As a consequence, it cost the trust and/or the Welsh Office some £800,000 to ensure that the site was safe before the hospital could be built.

Mr. Rogers: As an engineer and geologist by profession, when I had a proper job, I fully appreciate the problems that the designer might have had. I am still waiting for the Dungeness power station to fall down.

My hon. Friend is absolutely right. Unless standards are given and specifications followed, once they are diluted or are brought down to the level of health trusts, the in-house design capability will be inadequate to ensure that problems such as the incident that my hon. Friend has outlined do not take place.

Mr. Wardell: Does my hon. Friend agree that, because the Government have taken some rather stupid decisions--such as the transfer of all the coal records from south Wales to Bretby--when hospital trusts or any other trusts wish to establish new buildings, the cost of finding those records and seeing what they say adds enormously to the costs and poses difficulties, not only to the health service in Wales but, indeed, to everyone else?

Mr. Rogers: I entirely agree. That is why I hesitate to support the offloading of functions to the Welsh Office. The present Minister, of course, is faultless; but before he entered his post, some very dubious decisions were made.

We may talk of cost, efficiency, effectiveness, structures and the specification of contracts, but ultimately those who use the national health service will be affected by our decisions. We have a duty to deliver the best possible service. If that can be done better at Welsh Office level, fine, but it would be better still for it to be done at trust level. I have serious doubts about the advisability of establishing too many decision makers: one may end up simply passing the buck to the others.

I shall support the amendment, but I consider it deficient in some respects. It refers, for instance, to

"a duty to give directions to such Health Authorities as may be established".

Will those health authorities have common standards, or will they decide individually on different standards, thus creating a patchwork quilt of provision in Wales?

Mr. Morgan: Both.

Mr. Rogers: If that is so, and order will be maintained, I shall be quite happy; but if direction is to be centrally imposed, it must be consistent, coherent and generally agreed, and decisions must be made swiftly.

Mr. Ieuan Wyn Jones (Ynys Mo n): I am pleased to be able to speak in a debate that gives us a rare opportunity to consider some aspects of the health service in Wales. I am grateful to the hon. Member for Cardiff, West (Mr. Morgan) for drawing our attention to a number of important issues.

I am also grateful to the hon. Member for Rhondda (Mr. Rogers) for giving me an opportunity to respond to some of the points that he made. He seemed to suggest that I would not welcome cross-border co-operation; it may come as a nice surprise to him that I have always welcomed the fact that many of my constituents--and, indeed, members of my family--have benefited from the specialty services that exist in Merseyside--at the Clatterbridge centre, the Christie hospital and elsewhere. Long may that continue.

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The hon. Gentleman may also be interested to learn that my wife received an excellent training at the royal infirmary in Liverpool. I have no problem with the idea of cross-border movements, in terms of either specialties or staff. Let me go a little further than the hon. Member for Rhondda, and suggest that we need to adopt a strategic approach to both clinical and non-clinical health matters in Wales. The decision of the Welsh Office to market-test the Welsh Health Common Services Authority has caused great problems in Gwynedd. In preparation for the market-testing exercise, the authority decided to provide the Welsh Office with some examples of ways in which it could cut costs. It suggested, for instance, that the stores provision at Ysbyty Gwynedd should be closed, and that medical and other supplies should be provided from a store in Denbigh in the Vale of Clwyd. I have no problems with that; I know the area well, having lived there for many years, and my wife's family originated there.

Mr. Morgan: Before she went to Liverpool.

Mr. Jones: And since she went to Liverpool. I hope that the hon. Gentleman realises that I support his amendment. If he wants me to attack it, however, he is going the right way about it--particularly if he says some nasty things about my better half.

If medical and other supplies are transferred from Ysbyty Gwynedd in Bangor to Denbigh, it will not be possible to provide the same standard of service or to do so more efficiently. When Ysbyty Gwynedd was built in 1970, the stores were built alongside it. That meant that the wards were built without sufficient capacity to take on-site medical supplies. If the move takes place, there will not be enough space in the wards at Ysbyty Gwynedd to maintain sufficient supplies from time to time. Supplies will have to be transferred from the Vale of Clwyd by road, which will mean increased road traffic and increased costs.

That is the sort of decision that the Welsh Health Common Services Authority has already made, in an attempt to demonstrate to the Welsh Office that it can save money. But what will be the cost to the people of Gwynedd, who need a health service that is properly resourced and has sufficient capacity within the county to deliver medical and other supplies?

During the summer months in particular, it may be difficult for supplies to be brought quickly from the Vale of Clwyd to Bangor and other Gwynedd hospitals at times of emergency. We disapprove of the kind of decisions that are now being made, but if the amendment were accepted we could deal with the position, because the Welsh Office would have to give the authority guidelines on how it should discharge its responsibilities.

It is, after all, the responsibility of Government to ensure that medical and other supplies are available to hospitals when they need them. What will happen under market testing? If a private firm says that it will provide the services that the common health services authority currently operates, what comeback will there be if it proves unable to deliver those services?

The Minister said that the Government were currently considering only market testing of non-clinical supplies, and I accept that; but this is a first step towards further developments. Despite what some hon. Members have said, I will support the amendment, and urge the

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Government to do the same. From time to time, strategic decisions will have to be made that can be taken only at an all-Wales level.

Mr. Nick Ainger (Pembroke): The possibility of establishing fewer health authorities in Wales is one of the main aspects of the amendment. My constituency contains what is probably the smallest health authority currently operating in Wales--if not in England and Wales--and I am extremely concerned about the impact that the Bill may have not only on my constituency but on those of my hon. Friend the Member for Carmarthen (Mr. Williams), my right hon. Friend the Member for Llanelli (Mr. Davies) and the hon. Member for Ceredigion and Pembroke, North (Mr. Dafis).

This year's announcement of funds for the Pembrokeshire health authority was linked with the announcement relating to East Dyfed. In effect, a Dyfed health authority has already been created. But the indications are that Dyfed and Powys--the old, soon to be the former counties--will be united in a huge health authority, which would cover more than 50 per cent. of the service in Wales. Hon. Members who do not know Wales may find it interesting that it would be far quicker for me to travel from the extremity of my constituency to this place, than to travel from one extremity of the proposed health authority to the other side. It would probably take me twice as long to get from the far west of Dyfed to the far east of Powys than to travel to this place.

The objection to the Bill involves the lack of accountability inherent in it. In relation to local government in Wales and England, the Government are saying that small is beautiful and that local authorities should be getting closer to their electorate and to the people they represent. Unitary authorities will be in place in Wales from April 1996. It is remarkable that, in relation to the provision of health care, the Welsh Office may be saying the complete opposite: that big is beautiful, and that being further away from patients and people who need care is a far better system. That is extremely worrying.

8.30 pm

Many hon. Members on both sides of the House objected to the possibility of a reduction in the number of police authorities in Wales because of the lack of accountability, and because of the extremely effective performance of the smaller, in particular, rural police authorities. I would be worried if, because of the Bill, the Secretary of State for Wales could create extremely large health authorities.

Mr. Gareth Wardell: Does my hon. Friend agree that, as the Government are proposing to reduce the number of health authorities in Wales from 17 to five, it is vital to realise that some hospital trusts in Wales are relatively small, and that it would be helpful if some of them were amalgamated? Their delivery of services could then be improved, and the sort of duplication that occurs in some of them would not arise.

Mr. Ainger: I agree. I welcome the amalgamation of district health authorities with family health services authorities. I am concerned, however, that combining those authorities will create large organisations, which will in effect, because of the enormous areas involved, become extremely remote and difficult to organise. That

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is certainly the case with Dyfed-Powys, which I am concerned about. If the Secretary of State goes down the road of combining FHSAs with district health authorities, that will obviously cause administrative problems. Those two organisations have different roles.

Mr. Rogers: I am sure that my hon. Friend is right in some of what he is saying, but we should remember that we are seeking to amend the awful system that was created by a Tory Government in 1973. Before that, far more effective and closer delivery of health services took place. There were, for instance, hospital management committees, which were much more appropriate for some areas. The false structure set up by the Conservatives in 1973 has been so inefficient and so bad that it must be amended. It was amended once, and it is still being amended now. I still would not want large authorities to operate to the detriment of small units, with a personal delivery at hospital level.

Mr. Ainger: I agree. We must remember that the Bill is relevant only to health authorities--the purchasing authorities--and not to the running of hospitals. They must be sensitive to patient needs, because they are the ones that will be purchasing health care from the various trusts and from directly managed units. I do not want to be accused of making an awful pun, but they must obviously have their fingers on the pulse of what is required in their areas.

It is important to remember that it is only a couple of years since reorganisation. In Pembrokeshire, we saw the disastrous effects of that reorganisation, which followed the establishment of the Pembrokeshire NHS trust and of the purchaser-provider split. In September 1993, Pembrokeshire NHS trust and Pembrokeshire health authority, prompted behind the scenes by the Welsh Office, called in independent advisers to sort out the problem where they could not agree a contract between themselves. They had to approach the chief executive of Clwyd health authority, Mr. Brian Jones, and the finance director of the Wrexham Maelor hospital trust, Mr. David Galley, to consider what had happened since the establishment of the trust and, effectively, the emasculation of the then Pembrokeshire health authority.

It was an interesting report. Those two men spent three months in Pembrokeshire considering in great detail what had happened immediately before and immediately after the establishment of the trust. Their report makes interesting reading. It is certainly worth quoting. This is what those two experts in health care had to say about that reorganisation:

"the residents of Pembrokeshire did not receive any increase in the level of services provided, although increased levels of expenditure were taking place."

Pembrokeshire health authority lost virtually all its members of staff, bar two, to the new trust, because of the way in which purchasing staff had been transferred to the trust from the authority.

The report continues:

"a minimum of £750,000 has been diverted from purchasing health care for the Pembrokeshire population into additional purchasing management costs."

The money went into administration, not health care.

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We should not forget that the report was written by people who had spent virtually all of their working lives in the NHS and who were senior individuals. They went:

"there appears to have been a significant increase in the cost of employing a number of senior managers within the trust during its first year of operation."

Basically, that related to one particular individual, the then chief executive of Pembrokeshire NHS trust. Before the establishment of the trust, he had been general manager of the Pembrokeshire health authority, where he had received a salary of approximately £50,000. At the end of the first year of the operation of the trust, that individual, as chief executive of the trust, received a salary of £73,000--an increase of £23,000 in 12 months. By the end of the second year of the operation of the trust, he was receiving not £73,000, but £87,000. That is why we need to be careful, to establish a properly accountable system of health delivery, and to be sure that we do not make a mess of further reorganisations.

That individual has retired from the Pembrokeshire NHS trust under interesting circumstances. I am told that the chairman of the NHS trust was informed by the chief executive in December 1993 that he had completed virtually 30 years in the NHS, and that he was looking for pastures new. He joined the NHS from school and, even after completing 30 years of service, he was only 47.

Mr. Rogers: My hon. Friend is being extremely unkind. He does not realise--I am sure that the Minister will advise him later--that executives of health trusts are in enormous demand within industry and management outside the health service, as well as in America and Europe. They need to have their salaries doubled year after year so that they can be retained in the health service. I am sure that the Minister will put my hon. Friend right.

Mr. Ainger: I am not being unkind. I understand that the individual is now running an antique shop. His successor, who in my opinion had greater experience of running large organisations at senior level, was employed on a new contract. His total emolument is not £87,000, but £64,000. That is a significant saving. In the meetings that I have had with Mr. Stuart Fletcher, the new chief executive of the Pembrokeshire NHS trust, I have been extremely impressed with the quality of his performance and experience. It is interesting that Mr. Brian Davis told his chairman in December 1993 that he would like to leave the NHS trust to go to pastures new.

Madam Deputy Speaker (Dame Janet Fookes): Order. The hon. Gentleman is going into considerable detail. I hope that he can relate his comments more closely to the amendment under discussion. If not, it seems more like a general history.

Mr. Ainger: The essence is the lack of accountability within the current organisation in Wales. I am trying to enforce the point that we need an accountable system of administration in Wales in order to stop the abuse--I use that term advisedly--that has happened in the past.

We must never allow individual managers to assume certain powers, often because of the weakness and ineffectiveness of other members of the board who improperly control the way in which salaries escalate, allegedly under performance-related pay. It is worth referring to that, because the Jones Galley report said that, while that individual's salary was increasing in the two

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years that he was chief executive, the performance was going down, and the £750,000 was spent on administration, not on health care. It is vital that, if and when the new reorganisation takes place, it must maintain the true connection with our local communities, particularly in rural Wales. Large organisations find that difficult to do. It is important to ensure that, when we appoint new people to the boards, they know that they have a responsibility to ensure that the reorganisation is done smoothly, effectively and efficiently, and to ensure that we do not see a massive escalation in salaries.

Mr. Gareth Wardell: Does my hon. Friend agree that it is hoped that the Government will advertise all the posts that will become available on the new health authorities, including the role of chief executive, so that we can have open competition? Does he agree that no job that currently exists should be protected, but that they should all be open to anyone, whether executive or non-executive, so that we have the best people running the health authorities? Perhaps early retirement packages could be looked at soon, so that those who are reaching the stage at which they need to think about retirement can be assisted in that direction.

Mr. Ainger: I could not agree more. To illustrate my hon. Friend's point, it is interesting that, when the post of chief executive of the NHS trust in Pembrokeshire was first advertised, it referred to requiring somebody with business acumen. It did not mention health care or patients. That advertisement failed to lead to an appointment. After my intervention to point out the omissions, the post was readvertised, and included references to health care and requiring somebody with experience in the NHS. The excellent Mr. Stuart Fletcher was then appointed.

8.45 pm

Mr. Richards: The hon. Member for Rhondda (Mr. Rogers) made the best speech that I have ever heard him make. He spoilt it by supporting the amendment at the end. I agree with his first point--

Mr. Rogers: The Minister is being very unfair.

Mr. Morgan: My hon. Friend has a majority of only 64,000.

Mr. Rogers: I wish my hon. Friend would not take the words out of my mouth. I am in such a sensitive position with my parliamentary majority that any compliments from the Minister can only put me in jeopardy.

Mr. Richards: The hon. Member for Rhondda spoke about clinical effectiveness. The Government share his view, and attach a high priority to that. There are on-going trials. The Government also agree with the hon. Gentleman's point about centralisation. I am sure that he will agree that the health service reforms have devolved power and decision making to local people. His comments about the size of the Welsh Health Common Services Authority reflect the Government's view.

The hon. Gentleman referred to standards of design. The current standards and the need to maintain standards will remain, and a capacity will be needed at the centre, either within the Welsh Health Common Services Authority or within the Welsh Office, to monitor the

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projects. That will need a fairly small team, and the Welsh office will receive and consider all evaluations undertaken by trusts. The hon. Member for Ynys Mo n (Mr. Jones) gave one or two anecdotal examples of what I would call micro-level savings that might be made in Gwynedd. What we are doing with the Welsh Health Common Services Authority is on rather more of a macro-level. We are looking for greater efficiency and a better service. The hon. Gentleman made a serious point about the guarantee and continuity of supplies. It is for the customer--the trust or whoever--to ensure that continuity of supplies is maintained.

The hon. Member for Pembroke (Mr. Ainger) raised the small versus large issue. The Bill is not the end of the road, but is very much the beginning. We envisage that, over time, the purchasing role will shift more and more to GP fundholders. Decisions will therefore be made much closer to the patient than he fears would be the case with rather larger health authorities than he would wish. With regard to his point about salaries and so on, the my right hon. Friend the Secretary of State has made it clear that management costs must and should be kept under control, and, indeed, they include the salaries of senior executives within the trusts.

Mr. Morgan: I rise briefly to explain why I shall seek leave to withdraw the amendment.

The Minister mentioned, perhaps unwisely, the fact that Opposition Members supported one of the principles behind the Bill, but I do not think that he made any attempt to understand our objections. The idea of crossing the boundary between primary and secondary health care, in purchasing and commissioning--the new word, as the Government have a taboo about using the word "planning"--is one that the Minister does not seem to understand. We agree with crossing that boundary. We agree with merging family health service authorities and district health authorities, but the Government have demerged at the same time as they have merged.

They are demerging GP fundholders, who represent an ever-increasing proportion. The figure is expected to be 40 per cent. in Wales--it may be higher in England, but it is certainly less in Scotland--from April. They are being demerged from the merger. That is the problem that the Minister has not understood and which causes us difficulties. Indeed, we know from the documents that we have from his Department that it is causing the Welsh Office considerable difficulties.

How does one, having broken up Humpty-Dumpty, put him back together, when one has one created all these new animals that make their own purchasing and commissioning decisions? People have described the difficulty as one of herding cats in a thunder storm, but it was not me who said that, of course. When these alleged savings are created--I do not think that the Minister has dealt with this problem--what do we do with them?

The savings are known as "do-it-yourself top slicing". If anybody under the age of 15 is listening, it is not something that I would advise them to do at home. The Minister top-slices sums to release into waiting list initiatives or whatever, but GPs are now able to do that themselves. They can reserve money--it looks as though the figure will be £10 million in Wales and probably £200

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million throughout Britain--to spend as they want, in the same way that Ministers have the right to top-slice for special ministerial initiatives.

My hon. Friend the Member for Rhondda (Mr. Rogers) attempted to solve the fundamental problem of the health service: how does one have local initiative and national guidelines? I made the point earlier about the Wrexham Maelor to Cardiff stillborn baby scandal--perhaps the Minister will refer to it with respect to the Glan Clwyd baby theft issue. We all want a local inquiry to try to solve the problem and for the Minister to say, "What lessons have we learnt from the local inquiry? Do we need national guidelines?" Perhaps he should have been a bit clearer about what lessons could be learned at an all-Wales level from those individual incidents, which teach all of us a lesson. That is the way in which one bridges the gap between the need for decisions to be taken locally, but with the right to establish national guidelines for minimum standards when required.

Mr. Rogers: Surely the lessons are immediately apparent. When the Government issue instructions to health trusts to go outside to private contractors, they must impose particular standards. That is self-evident. We do not need a massive inquiry involving hundreds of thousands of pounds. Something should be done at a local level. It is all about controlling private contractors.

Mr. Morgan: I entirely appreciate that; otherwise those scandals occur, and our functions as politicians is to slam the stable door shut with as much panache as we can, finding a new locksmith and so on, while trying to persuade the public to forget that the horses have been stolen in the first place. We are concerned that the Government are not good at listening when, if they have to listen, it cuts across the dogma.

The Minister said that he was happy with the consultation on the artificial limb and appliance service in Wales and that he will preserve necessary all -Wales services, but he will have seen the scathing letter from the British Limbless Ex-Servicemen's Association about the break-up of that service. I hope that he will reconsider the matter.

I apologise to the hon. Member for Ynys Mo n (Mr. Jones) for any misunderstandings between him and me, as we are undoubtedly on the same side of the issue tonight. I am sure that we will be able to agree on any remarks that I made but which he may have misheard. I want to know whether we received a genuine concession from the Minister on in-house bids for the Welsh Health Common Services Authority. He told me that I was wrong and that in-house bids would be allowed. I have to tell him that at a face-to- face meeting with the chairman, the chief executive, two union officials-- one lay, one full-time--and several senior officials, the chairman told me that he had been instructed by the Welsh Office not to allow any in-house bids. I cannot do better than that. That is the information that I was given.

Mr. Richards: Let me make it clear to the hon. Gentleman, so that there is no misunderstanding, that no

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instruction has gone from my Department to the Welsh Health Common Services Authority to exclude in-house bids.

Mr. Morgan: The authority seems to have developed the opposite impression. Perhaps I should try to clarify that, and perhaps the Minister will as well.

My hon. Friend the Member for Pembroke (Mr. Ainger) made some extremely important points about the accountability of the health service, particularly of some of the rip-roaring practices that have occurred in the pay of chief executives, their perks and early retirement. In Pembroke, what is known as Bennett's folly occurred when one of my hon. Friend's predecessors, just before an election, formed a trust because the Government were determined to have a trust in place before the election.

When the chief executive took early sick leave--I understand that he had been driving a Porsche, which had been paid for by the health authority, and he developed backache, because Porsches tend to have that effect--it is believed locally that he wrote on the application the reason for his illness as "Munchausen's syndrome by Porsche". The lesson for everybody is not to go for flashy cars if one is in a senior position in the health service.

That was symptomatic of what was going wrong with Ministers exceeding their powers, or letting their vision of a new dogmatic health service overtake sensible planning of what the people of Wales wanted. It was also one of Bennett's follies to send the Welsh Health Common Services Authority to a new, expensive skyscraper office block, which has now become the target of the next Secretary of State's desire to eliminate bureaucrats in the health service. The Minister's predecessor has two black marks against him for the problems that he has created for people working in the health service.

The predecessor before that was the Secretary of State who, of course, had all the wonderful pleasures that the present Secretary of State wants by virtue of this Bill, to decide how many health authorities there should be. His predecessor but one, Lord Crickhowell, decided that he wanted a local health authority for Pembroke and set up an additional health authority but the present Secretary of State wants to rationalise health authorities. It must be wonderful for Secretaries of State to be able to decide how many health authorities they can have, while the House does not have a great deal of opportunity to establish proper criteria to determine how many we need in Wales. If we are really to decide how many health authorities there should be in Wales, the job should possibly be left to a Welsh Assembly after the next election.

Madam Deputy Speaker: Is the hon. Gentleman seeking leave to withdraw the amendment?

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